Routine Laboratory Test Indices for COVID-19

Patient Management
Hematology Test Indices

Symptom* Onset Admission Hospitalization

Discharge**
Test Parameter Reference Interval (Reference from COVID-19
9 days (median) 12 days (median) Dessignated Hospitals, China)

White blood cells Survivals Shifting with slight increasement within the reference range1
4.0-10.0 x10 /L9
Normal, or slightly elevated > 3.0 x109/L
(WBC) None-survivals Exceeding the upper reference range1
Survivals Prograssively decreasing, followed by recovering climbing back.

Lymphocyte number None-survivals Persistent decrease, fluctuating at low level (below 0.8 x109/L)1
0.8-4.0 x109/L Normal, or slightly decreased > 1.0 x109/L
(Lym#)
In Mindray COVID-19 retrospective study, AI acquired Lym# & RDW-SD parameter
(unpublished, requiring further verification) > 0.794 could predict severe progression.

Monocyte number Monocyte deform to phagocyte, engulfing virus. In the deterioration

0.12-1.2 x109/L Normal, or slightly decreased process, Mon cell cluster appears some sudden change in SF CUBE (Mindray 0.12-1.2 x109/L
(Mon#) unpublished retrospective study).
W
Neutrophil number Survivals Prograssively increasing, rising slowly within the reference range1
B (Neu#)
2.0-7.0 x10 /L
9
Normal, or slightly elevated
None-survivals Prograssively increasing, exceeding the upper reference range1
> 1.5 x109/L

C
Eosinophil number
0.02-0.5 x109/L Normal, or slightly decreased Progressively decreasing, some will fall out of the lower reference range3 0.02-0.5 x109/L
(Eos#)

High fluorescent
0.00 x109/L Normal, or slightly increased Some results will be flagged with atypical lymphacyte. 0.00 x109/L
Cell number (HFC#)

Neutrophil-to- Elderly patients (>50 years) with NLR>3.13 are recommended to transfer to ICU2
Cutoff: 3.132 Normal, or slightly increased NA
lymphocyte ratio (NLR)

NLR & RDW-SD Patients with NLR & RDW-SD > 1.06 can be classified as the severe
Cutoff: 1.064 Normal, or slightly increased progression for more intervention therapy4 NA

Reticulocyte number
R (Ret#)
0.02-0.20 x1012/L > 0.02 x1012/L
Normal, or slightly increased, Severe and critially ill patients will have high Ret count and IRF (Mindray
B could decrease in severe cases unpublished retrospective study).
Immature Reticulocyte
C Fraction (IRF)
0.0-25.0 % 0.0-25.0 %
/
R Hemoglobin
(HGB) 110-160 g/L Normal, or slightly decreased Progressively decreasing, then rising back during recovery > 90 g/L
E Red blood cell distribu-
T tion width – standard 35.0-56.0 fl Normal, or slightly increased
Progressively increasing, can be combined with other parameters for severity
indentification or prediction. 35.0-56.0 fl
deviation (RDW-SD)5

Normal, or slightly increased, In the well-controlled cases, PLT rises progressively, then declining during recovery
Platelet count 100-300 x109/L > 80 x109/L
(PLT) could decrease in severe cases Decreasing with septic deterioration , then rising back during recovery
6

P Platelet Distribution 6.5-12.0 fl Normal, or slightly increased Progressively increasing, then going down during recovery 6.5-12.0 fl
Width (PDW)
L
Immature Platelet
T Fraction (IPF)
0.9-10.0 % Normal, or slightly increased Progressively increasing, then going down during recovery 0.9-10.0 %

Platelet-large cell count 30-90 x109/L Normal, or slightly increased Progressively increasing, then going down during recovery 30-90 x109/L
(P-LCC)

C
R Full-range C-reactive
protein (FR-CRP)
0.00-4.00 mg/L Slightly increased Progressively increasing, CRP > 34mg/L plus age > 60 years indicating high
probability of mortability in 12 days7
0.00-4.00 mg/L

P
*Symtoms: fever, cough, breathing difficulties, headache, diarrhea
**Discharge: Under the premise that the patient's nucleic acid test result is negative for two consecutive days (alveolar lavage fluid is recommended8)

CLIA Test Indices

Test Parameter Reference Interval Clinical Significance Caution

Acute cardiac injury (elevation of cTnI to >99th percentile) is associated with more severe COVID-19
99th Percentile: disease1,9,10.
cTnI
0.04 ng/mL
COVID-19 patients with elvated cTnI is associated with worse prognosis11. Assays for troponins and BNP
should be obtained only for such
For COVID-19 patients with clinical evidence for heart failure, BNP could aid in the diagnosis of patients who have clinical signs of
congestive heart failure12. acute myocardial infarction (MI) or
Cut off for heart failure: heart failure, respectively.
BNP Natriuretic peptide estimates a potentially useful approach in patients with severe COVID-19 to
100 pg/mL
distinguish between cardiac and pulmonary cause of dyspnea, to risk-prognosticate the patients,
and to guide and monitor therapy13.

SARS-CoV-2 infection could not cause an elevated PCT concentration. Procalcitonin is typically PCT is not a substitute for good
normal on admission, but may increase among those admitted to the ICU14. clinical judgement and cannot be
PCT 0.12-1.2 x109/L
Increased PCT is a risk factor associated with in-hospital death, and of the COVID-19 patients who used in isolation.
died around half had a secondary bacterial infection leading to sepsis and death1.

Increased ferritin level might correlate to secondary bacterial infection and associated with poor
clinical prognosis15.
FERR 2.0-7.0 x109/L Elevated ferritin is a marker to assess COVID-19 severity16.
An elevated serum ferritin test is an indicator for systemic inflammatory response syndrome, which
could cause rapid deterioration of COVID-19 patients17.

In patients with COVID-19, IL-6 levels are significantly elevated and associated with adverse clinical
outcomes18.
IL-6* / Aviliable soon.
Given the association of elevated IL-6 with severe COVID-19 and mortality, clinicians should use this
as a potential marker to recognize severe disease19.

Biochemistry Test Indices

Test Parameter Reference Interval Clinical Significance

Male: < 248 U/L ,

< 4.13 μkat/L LDH level can reflect the injury degree of lung, kidney and heart. Most COVID-19 patients had elevated LDH.18 LDH level can help
LDH evaluate the prognosis and predict the mortality of COVID-19 patients.
Female: < 247 U/L,
< 4.12 μkat/L

The significant increase of CRP has been reported in most COVID-19 patients.19 CRP testing is useful in the evaluation of coronavirus infection
CRP <5.0mg/L and reflect the inflamation status.

Male: 30-400 ng/mL
FER
Female: 15-150 ng/mL
All patients with severe COVID-19 should be screened for hyperinflammation using laboratory trends (eg, increasing ferritin, decreasing
platelet counts, or increasing erythrocyte sedimentation rate).
The serum ferritin has a role in predicting in-hospital mortality. Levels of serum ferritin was clearly elevated in non-survivors compared with
survivors throughout the clinical course, and increased with illness deterioration.1

Many studies found that D-dimer levels is increased for severe patients.Having D-dimer greater than 1 μg/mL are the factors that could
D-Dimer ≤1.0 μg/mL help clinicians to identify patients with poor prognosis at an early stage.1
References:

[1]. Fei Zhou, Ting Yu, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet (2020). doi:
10.1016/S0140-6736(20)30566-3
[2]. Jingyuan Liu, Yao Liu, Pan Xiang, et al. Neutrophil-to-Lymphocyte Ratio Predicts Severe Illness Patients with 2019 Novel Coronavirus in the Early Stage. Medrxiv. doi:
10.1101/2020.02.10.20021584
[3]. Jin-jin Zhang, Xiang Dong, Yi-yuan Cao, et al. Clinical characteristics of 140 patients infected with SARSCoV-2 in Wuhan, China. Allergy. 2020 Feb 19. doi: 10.1111/all.14238.
[4]. Wang CZ, NLR&RDW-SD: Indices for Identifying Severe COVID-19 Patients (to be published officially). https://www.mindray.com/en/presscenter/NLR_RDW-SD__Indices_-
for_Identifying_Severe_COVID-19_Patients.html
[5]. Ephrem G., Red Blood Cell Distribution Width Should Indeed Be Assessed with Other Inflammatory Markers in Daily Clinical Practice. Cardiology. 2013;124(1):61. doi: 10.1159/000345925.
[6]. G. Lippi, M. Plebani, B. Michael Henry, Thrombocytopenia is associated with severe coronavirus disease 2019 (COVID-19) infections: A meta-analysis, Clinica Chimica Acta (2020). doi:
10.1016/j.cca.2020.03.022
[7]. Jiatao Lu, Shufang Hu, Rong Fan, et al. ACP risk grade: a simple mortality index for patients with confirmed or suspected severe acute respiratory syndrome coronavirus 2 disease (COVID-19)
during the early stage of outbreak in Wuhan, China. medRxiv. doi: 10.1101/2020.02.20.20025510
[8]. Xiao-Hong Yao, Zhi-Cheng He, Ting-Yuan Li, Hua-Rong Zhang, et al. Pathological evidence for residual SARS-CoV-2 in pulmonary tissues of a ready-for-discharge patient. Cell
Research (2020) 0:1–3. doi: 10.1038/s41422-020-0318-5
[9]. Wang D., Hu B., Hu C., et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA, 2020.
[10]. Lippi G., Lavie C.J., Sanchis-Gomar F. Cardiac troponin I in patients with coronavirus disease 2019 (COVID-19): Evidence from a meta-analysis. Prog Cardiovasc Dis, 2020.
[11]. Ruan Q., Yang K., Wang W., Jiang L., Song J. Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China. Intensive Care Med, 2020.
[12]. James L. Januzzi Jr. American College of Cardiology: Troponin and BNP use in COVID-19.
[13]. Kunal Mahajan, Prakash Chand Negi. The role of natriuretic peptide estimation in severe COVID-19.Monaldi Archives for Chest Disease, 2020.
[14]. Interim Clinical Guidance for Management of Patients with Confirmed Coronavirus Disease (COVID-19). US CDC.
[15]. Bo Zhou, et al. Utility of Ferritin, Procalcitonin, and C-reactive Protein in Severe Patients with 2019 Novel Coronavirus Disease.
[16]. Clinical guide for the management of critical care for adults with COVID-19 during the coronavirus pandemic. UK NHS.
[17]. Colafrancesco S, et al. COVID-19 gone bad: A new character in the spectrum of the hyperferritinemic syndrome?. Autoimmun Rev. 2020.
[18]. Coomes E, et al. Interleukin-6 in COVID-19: A Systematic Review and Meta-Analysis. doi: https://doi.org/10.1101/2020.03.30.20048058
[19]. Aziz M, Fatima R, Assaly R. Elevated Interleukin-6 and Severe COVID-19: A Meta-Analysis. J Med Virol. 2020.

Mindray’s total laboratory solutions assisted frontline health workers in fighting COVID-19 in China’s
Leishenshan and Huoshenshan Hospitals, two emergency specialty filed hospitals built in mere a few
days in response to the coronavirus.